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Successful reconstruction of an ankle defect with free tissue transfer in a hemophilia A patient with repetitive hemoarthrosis:A case report

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World Journal of Clinical Cases 2023年第17期11卷 4079-4083页

作者： Dong Yun Lee SooA Lim SuRak Eo Jung Soo Yoon Department of Plastic and Reconstructive Surgery DongGuk University Medical CenterGoYang 10326South Korea

BACKGROUND Hemophilia, an uncommon yet consequential hereditary bleeding disorder, manifests as two clinically indistinguishable forms that hinder the normal functioning of the coagulation cascade. This impairment renders individuals more susceptible to excessive bleeding during significant surgical interventions. Moreover, individuals with severe hemophilia frequently encounter recurring hemarthrosis, resulting in progressive joint destruction and, subsequently, the need for hip and knee replacement *** SUMMARY The patient was a 53-year-old man with hemophilia A as the underlying disease and had self-injected factor Ⅷ twice weekly for several decades. He had undergone ankle fusion surgery for recurrent hemarthrosis at the Department of Orthopedic Surgery 1 mo prior and was referred to our department because of skin necrosis after a hematoma at the surgical site. An anterolateral thigh perforator free flap was created after three cycles of factor Ⅷ administration in addition to the concomitant administration of tranexamic acid(TXA)(Transamin 250 mg cap, 1 cap tid, q8h). After the operation, from postoperative days(PODs) 1-5, the factor Ⅷ dose and interval were maintained, and q12h administration was tapered to q24h administration after POD 6. Because the patient’s flap was stable 12 d after the operation, factor Ⅷ administration was tapered to twice a week. At 6 mo follow-up, the patient recovered well without any *** To the best of our knowledge, there are very few reports of successful free flaps in patients with hemophilia, and none have been reported in patients with hemophilia A. Moreover, there are several reports on the efficacy of TXA in free flaps in general patients;however, there are no case reports of combining factor Ⅷ and TXA in patients with hemophilia. Therefore, we report this case to contribute to future academic research.

关键词： free tissue transfer Anterolateral thigh free flap Hemophilia A Hemoarthrosis Factor VIII Tranexamic acid Case report

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The submental island pedicled flap and supraclavicular artery island flap in a free flap practice

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Plastic and Aesthetic Research 2022年第1期9卷 225-232页

作者： Adnan S.Hussaini Urjeet A.Patel Department of Otolaryngology-Head&Neck Surgery Northwestern University Feinberg School of MedicineChicagoIL 60611USA Department of Otolaryngology-Head&Neck Surgery John H.Stroger Hospital of Cook CountyChicagoIL 60612USA

Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system *** trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps(LRPF);however,the latter group is often undervalued,offering high utility,practicality,and cost-efficiency whilst providing equivalent *** submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.

关键词： Head and neck reconstruction free tissue transfer locoregional pedicled flap cost efficiency oral cavity oropharynx

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Comparison of outcomes between early and delayed weight bearing following lower limb free flaps:an 18-month single-center study

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Plastic and Aesthetic Research 2023年第1期10卷 656-662页

作者： Majid Al-Khalil Manuela Roman Ahmed Emam Nicholas Marsden Welsh Centre for Burns&Plastic Surgery Morriston HospitalSwansea SA66NLUnited Kingdom Major Trauma Centre University Hospital of WalesCardiff CF144XWUnited Kingdom

Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight *** aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 *** 4)and weight bearing(day 5 *** 14)post lower limb free flap ***:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap *** data were collected from the comprehensive lower limb free flap database,medical notes,and electronic *** prescribed an extended non-weight-bearing period due to the method of bone fixation were ***:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for *** mean age was 43(17-72)with a M:F of 3:*** was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both *** differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.

关键词： Lower limb reconstruction free flap free tissue transfer weight bearing post-operative complications

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Reconstruction of extremity long bone defects with vascularized fibula bone grafts

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Plastic and Aesthetic Research 2019年第6期6卷 1-12页

作者： Corinne Wee DanieI Ruter Steven SchuIz Geoffroy Sisk JuIie West Scott TintIe Ian VaIerio Division of Plastic and Reconstructive Surgery in the Department of Surgery Case Western Reserve UniversityClevelandOH 44106USA Division of Plastic and Reconstructive Surgery in the Department of Surgery Albany Medical CollegeAlbanyNY 12208USA Department of Plastic and Reconstructive Surgery The Ohio State UniversityColumbusOH 43212USA Department of Orthopaedic Surgery Walter Reed National Military Medical CenterBethesdaMD 20889USA

Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.

关键词： Vascularized bone vascularized bone grafts composite extremity defect restoration bone reconstruction free tissue transfer microsurgery

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Soft tissue coverage of lower extremity defects:pearls and pitfalls in the chronic wound population

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Plastic and Aesthetic Research 2022年第1期9卷 371-386页

作者： Romina Deldar Chamilka Merle Christopher E.Attinger Karen K.Evans Department of Plastic and Reconstructive Surgery MedStar Georgetown University HospitalWashingtonDC 20007USA Department of General Surgery MedStar Georgetown University HospitalWashingtonDC 20007USA

The incidence of chronic lower extremity(LE)wounds continues to *** limb amputations are associated with increased cardiovascular exertion,further decline in functional ability,and higher mortality *** such,there has been a shift towards limb salvage *** include local debridement with advanced wound care,revascularization,bony reconstruction,and soft tissue *** planning for soft tissue reconstruction requires careful consideration of several factors,including patient comorbidities,wound size and location,exposed underlying structures,and in the case of possible free flap,patency of donor and recipient *** article reviews the perioperative factors that should be considered in preparation for successful soft tissue reconstruction of the LE.

关键词： free tissue transfer chronic wounds lower extremity reconstruction

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free tissue reconstruction of the anterior skull base:A review

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 132-136页

作者： Elizabeth Bradford Bell Erin R.Cohen Zoukaa Sargi Jason Leibowitz Department of Otolaryngology University of Miami Miller School of MedicineMiamiFLUSA

Objective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ***,when open resection is required,free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for *** articleaims to providea focused review of free flaps most commonly used in anterior skull base ***:This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles,queried using PubMed and Google ***&conclusion:Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing,particularly with large defects,post-radiation,and in at-risk *** type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the *** review offers insight into the numerous reconstructive options for the free flap surgeon.

关键词： free tissue transfer Anterior skull base Head and neck microvascular Reconstruction

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